Phobias

• The DSM stands for the Diagnostic and Statistical Manual of Mental Disorders and it is used to diagnose mental disorders. The DSM system is used to classify mental health problems and the current version is the DSM-5.
• A phobia is an anxiety disorder and is an extreme, irrational reaction to an object or a situation.
• The DSM recognises the following categories of phobias and related anxiety disorders:

  • specific phobias - object/stimuli
  • social anxiety (social phobia) - fear of social situations e.g public speaking
  • agoraphobia - fear of outside spaces or public areas without the ability to exit or escape.
• Behavioural characteristics of phobia:

  • panic - crying, screaming, running away
  • avoidance - conscious effort to get away from fear which may affect daily life
  • endurance - person may stay in the room with phobia to keep an eye on it
• Emotional characteristics of phobia:

  • anxiety
  • fear
  • emotional response is unreasonable/irrational
• Cognitive characteristics of phobias:

  • selective attention - difficulty looking away from phobic stimuli & concentrating on other things
  • irrational beliefs - thoughts about phobia have little to no basis in reality
  • cognitive distortions - inaccurate/unrealistic perception
• The two-process model

  Mowrer proposed the two-process model based on the behavioural approach to phobias:

  1. phobias are acquired by classical conditioning
  2. phobias are maintained through operant conditioning
• The behavourist explanation of phobias is focused on explaining the behavioural aspects of phobias - avoidance, endurance and panic.
• Research demonstrating acquisition of phobias:

  Watson and Rayner created a phobic response towards white rats (and ultimately anything with white fur) in 9 month old baby Little Albert using classical conditioning:

  • white rat (NS) → no response
  • loud noise (UCS) → fear (UCR)
  • white rat (NS) + loud noise (UCS) → fear (UCR) - paired and repeated several times
  • white rat (CS) → fear (CR)
• Acquisition of phobias via classical conditioning

  • person learns to associate something which we initially have no fear (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus)
• Maintenance of phobias via operant conditioning

  occurs via negative reinforcement: when an individual avoids a situation that is unpleasant and this therefore increases the behaviour.

  • Mowrer therefore explains whenever we avoid a phobic stimulus we successfully escape the fear and anxiety that we would have experienced if we had remained where we were.
  • This reduction in fear reinforces the avoidance behaviour so the phobia is maintained.
• A strength of the behavioural explanation of phobias is that it has evidence supporting its claims that phobias are learned through traumatic experiences. An example is the Little Albert study by Watson and Rayner as well as Jongh et al who found that 73% of people who fear dental treatment had experienced a traumatic experience, compared to a control group who had low dental anxiety where only 21% had experienced a traumatic event. This strengthens the behavioural explanation of phobia as its supporting evidence means it has good explanatory power.
• A strength of the behavioural explanation of phobias is that it has real-world application in exposure therapy. Mowrer's two-process model allowed therapists to understand how phobias are learnt and maintained over time. Therefore, to treat phobias a patient would have to be exposed to their feared stimulus and not be allowed to avoid it to prevent their behaviour and in turn, the phobia being reinforced. This therefore strengthens the behavioural explanation of phobias as it led to methods of treating phobias such as flooding and systematic desensitization.
• A weakness of the behavioural explanation of phobias is that it is an incomplete explanation of phobias. This is because it ignores evolutionary factors that have contributed to the development of phobias of snakes or the dark which are associated with the past, where it was adaptive to have these fears. Seligman called this biological preparedness, which is the innate predisposition to acquire certain fears. This then weakens the behavioural explanation because it means that there is more to acquiring phobias than simple conditioning.
• A weakness of the behavioural explanation of phobias is that it is deterministic. This is because the two-process model suggests that following a traumatic event, an individual uses this event to draw an association between a neutral stimulus and an unconditioned response and develop a phobia. However, this is not always the case as phobias don't always follow trauma. This weakens the behavioural explanation of phobias as it ignores free will and depicts humans as being dictated by our environmental experiences.
• The behavioural approach to treating phobias includes the use of systematic desensitization and flooding.
• Systematic desensitisation

  Treatment is designed to gradually expose an individual to a phobic stimulus to reduce anxiety

  • uses the principles of classical conditioning
  • when the phobic stimulus is paired with relaxation instead of anxiety, it allows the individual to learn a new response (counter-conditioning)
  • if a person can learn to relax in the presence of their phobia, then they will be cured
• 3 processes involved in systematic desensitisation

  1. relaxation - individual is taught relaxation techniques e.g. breathing techniques
  2. anxiety hierarchy - patient and therapist develop a hierarchy that lists situations related to phobic stimuli that provoke anxiety arranged in order from least to most frightening
  3. exposure - patient gradually moves their way up the hierarchy through gradual exposure until they are completely relaxed in the most feared situation.
• Systematic desensitisation can occur in vitro, where the client imagines exposure to the phobic stimulus or in vivo, where the client is actually exposed to the phobic stimulus.
• A strength of systematic desensitisation as a treatment of phobias is that it is effective. For example, Gilroy et al followed up on 42 patients who had been treated for spiders using systematic desensitization and found that at 3 months and 33 months after treatment, the systematic desensitization group was less fearful of spiders than the control group, which was only treated with relaxation and no exposure. This strengthens systematic desensitization as a treatment of phobias because it has good supporting evidence showing its effectiveness.
• A strength of systematic desensitisation as a treatment of phobias is that it is acceptable to patients. This is because typically patients prefer it over flooding. After all, it is less distressing and produces the same results flooding would without causing the same degree of trauma. This strengthens systematic desensitization as a treatment of phobias because it is viewed as more ethical and pleasant than flooding, therefore encouraging patients to seek treatment.
• A weakness of systematic desensitisation as a treatment of phobias is that it is time-consuming. This is because for systematic desensitization to be effective for an individual, they typically need to undergo 4-6 sessions lasting around 30-60 minutes. Those who have more severe phobias usually require more sessions to completely cure their phobias. This weakens this treatment of phobias as it may be too slow for some who may need to overcome their phobia quickly, or have busy lives and cannot spare that much time to overcome a phobia.
• A weakness of systematic desensitisation as a treatment of phobias is that it is not effective for all phobias. Ohaman et al suggested that systematic desensitization may not work for phobias with an underlying evolutionary survival component e.g. fear of the dark, heights or dangerous animals compared to fears that followed a personal traumatic experience. This then weakens systematic desensitization as a treatment of phobias as it can be argued that is only useful at tackling only some phobias, not all.
• Flooding

  • involves exposing a person with a phobia to their phobic stimulus but without a gradual build-up
  • involves immediate exposure to a very frightening situation
  • sessions often last 2-3 hours
• How does flooding work?

  • does not allow patient to avoid their phobic stimulus so they quickly learn that their phobic stimulus is harmless (extinction)
  • stops phobic responses quickly
  • if therapist allows client out too early, then they will run the risk of reinforcing the phobia as client would have successfully managed to avoid the phobic stimulus
• A strength of flooding as a treatment of phobias is that it is quick and cost-effective. This is because flooding is a single session treatment that lasts around 2-3 hours. This strengthens the treatment because its cheap nature means that it can be available on the NHS and its quick effect means that patients are free of their symptoms as soon as possible, so do not have to sacrifice much of their time encouraging patients to seek treatment.
• A strength of flooding as a treatment for phobias is that it has supporting evidence. For example, Choy et al found that flooding was more effective than systematic desensitisation in treating phobias. This strengthens the idea that flooding is an effective treatment for phobias.
• A weakness of flooding as a treatment for phobias is that the treatment is traumatic for patients. This is because the patient is exposed to the phobic stimulus immediately and patients are told not to avoid their phobic stimulus which causes them to experience great distress. The traumatic nature of flooding weakens it as a treatment for phobias because patients are often unwilling to see it through to the end due to their distress.
• A weakness of flooding as a treatment for phobias is that it is not effective for all phobias. For example, it may be less effective for social phobias as they involve cognitive aspects such as irrational thoughts about a social situation which flooding fails to address. This limits flooding as a treatment for phobias because it only tackles behavioural aspects, so social phobias would be better cured by cognitive therapies that tackle irrational thinking.